HomeMy WebLinkAboutDelta Dental Benefits 2012
Delta Dental of Minnesota
Welcome to Delta Dental of Minnesota.
Frequently Asked Questions
We’ve designed your dental plan so it is easy
to use and gives you and your family
May I visit any dentist?
maximum flexibility, network savings, an
You have the freedom to see any dentist. However, dentists who
unparalleled commitment to service and
participate in our networks have agreed not to charge more than our
peace of mind. Together with your
maximum allowable amount. This can result in lower out-of-pocket
employer, our goal is to help you maintain
costs. As an added convenience, you never have to file a claim when
healthy, happy smiles all year round.
you use a participating dentist—the dentist files the claim for you.
Prevention is the key to good
How do I find a participating dentist?
long-term oral health
Finding a participating dentist is easy. Simply visit
Our plans are designed to encourage you to www.deltadentalmn.org and use our interactive Dentist Search tool or
call Customer Service toll free at 1-800-553-9536.
visit the dentist and help ensure your basic
dental needs are met in a timely, cost-
What happens if I visit a non-participating dentist?
effective manner.
If dental services are received by a non-participating dentist, you will be
Access to regular checkups and sound
responsible for paying the difference between our maximum allowable
preventive care are key to long-term oral
amount and what the dentist charges. You may be responsible for
health. In addition to visiting your dentist for
submitting your own claim. The address to submit claims is on the back
regular preventive care, talk to your dentist
of your Delta Dental ID card. In addition, reimbursement for covered
about your specific oral health needs. Your
services will be paid directly to you.
dental plan is intended only to help you pay
for careyour dentist is the one who will
What if I have an emergency outside the United States?
—
help you determine your actual care needs.
Delta Dental automatically includes international emergency coverage
in many countries throughout Europe, Africa, South America and Asia.
Helpful Online Tools
English-speaking customer service representatives are available to help
members find a dentist. For more information, visit
As part of our commitment to your long-term
www.deltadentalmn.org.
oral health, we provide members free access
to valuable oral health information and dental
How do I find out if my claim was paid?
benefit tools through our Web site,
Our Web site offers fast and easy dental benefit tools and information.
www.deltadentalmn.org.
In addition to claims inquiry, other interactive features include benefits
and eligibility inquiry, oral health resources and much more. You may
also call Customer Service to get claims status and payment
information.
How is work in progress handled?
For services started prior to your effective date under the Delta Dental
plan, payment of the claim is generally based on the service completion
date.
How do I know how much I’ll be responsible for?
For major dental procedures, the dentist can submit a pre-treatment
An innovator in oral health benefit plans, Delta
estimate to Delta Dental of Minnesota for determination of benefits and
Dental of Minnesota is an independently
financial responsibility prior to the service.
operated, nonprofit dental services company that
administers self-insured and prepaid dental
service plans. Delta Dental of Minnesota is
To learn more about your dental plan, please contact us toll free at
headquartered in Eagan, and has a customer
1-800-553-9536
service center on Minnesota’s Iron Range.
www.deltadentalmn.org
or visit
Comprehensive Standard
Summary of Dental Benefits
Diagnostic & Preventive Services 100%
Basic Restorative Care & Services 80%
Basic Endodontic Therapy 80%
Basic Periodontal Services 80%
Complex Surgical Periodontal Care 80%
Basic Oral Surgery Services 80%
50%
Major Restorative Services
50%
Prosthetic Services
50%
Prosthetic Repairs & Adjustments
50%
Implants
$25 per covered person per calendar year, $75 maximum per family per calendar year
Deductible:
(Not applicable to Diagnostic & Preventive Services)
Annual Maximum: $1,000 per covered person per calendar year
Eligible Dependents:
Spouse and/or dependent children to the age of 26
Diagnostic & Preventive Services
Basic/Complex Periodontal Services
Examinations and cleanings at 6 month intervals Non-surgical periodontics at 36 month
Full mouth x-rays at 5 year intervals intervals
Bitewing x-rays at 12 month intervals for covered Surgical periodontics at 36 month intervals
persons through age 17, and at 24 month intervals
Basic Oral Surgery Services
for covered persons age 18 and over
Fluoride treatment at 12 month intervals for Surgical/Non-surgical extractions
covered persons through age 18
Major Restorative Services
Basic Restorative Care & Services Crowns at 5 year intervals
Emergency treatment for relief of pain
Amalgam restorations (silver fillings) Prosthetic Services
Anterior (front) resin restorations (white fillings)
(Missing tooth exclusion applies for 24 months)
Sealants for eligible dependents through age 15, Dentures (full and partial) at 5 year intervals
limited to once per lifetime for permanent molars Bridges at 5 year intervals
Space maintainers are covered once per lifetime
Prosthetic Repairs & Adjustments
for eligible dependent children though the age of
16 for missing primary posterior (back) teeth Denture adjustments and repairs
Re-cement bridge
Basic Endodontic Bridge repair
Therapy
Pulpotomies on primary teeth for dependent
childrenImplants
Root canal therapy on permanent teeth
This product utilizes the Delta Dental Premier network.
Claim payments are subject to review. We strongly recommend a pre-estimate for implants and all major services.
Complete details, limitations and exclusions will be provided in the contract upon enrollment.
In the event of a conflict between this benefit summary and the contract, the contract will apply.
1074_Delta_0309
Delta Dental of Minnesota
P.O. Box 9304 Minneapolis, MN 55440-9304